The deconstructing airway devices generally relate to respiratory equipment and more specifically to a device that spreads the jaws of a patient to open the patient's airway for a medical procedure.
A core skill required in the practice of Anesthesia, Critical Care and Emergency Medicine and increasingly in other specialties such as cardiology that involve invasive procedures in which varying levels of sedation are given to patients is the maintenance of an open airway for spontaneously breathing patients and a patent passage for gases (e.g. oxygen) to allow ventilation in the obtunded and apneic patient. There are a myriad of airway devices to support these skills, all by creating a physical passageway to the hypopharynx and tracheal opening or through the trachea. None of these devices are tolerated by an awake or moderately sedated patient because they touch areas of the oro-naso and hypopharynx that elicit a powerful gagging and coughing reaction.
The patent human airway in which there is adequate and life supporting flow of gas to the lungs depends on the anatomy of the soft tissues of the tongue, palate and pharynx, the bones and joints of the face, and importantly the tone of the muscles embedded and animating these structures. As a person becomes somnolent, sedated or obtunded, tone decreases, the soft tissues collapse, and the mandible drops backward resulting in airway obstruction causing inadequate or no air movement even if the patient is still adequately breathing, with possible hypoxia leading, untreated, to death. This occurs even in sleep and can be pathologic with health consequences in Obstructive Sleep Apnea associated very strongly with obesity. Difficulty maintaining the airway even with very mild levels of sedation is also associated with obesity. Patients who are being anesthetized or deeply sedated will pass through a stage of light sedation both when being sedated and when awakening. This state is dangerous and difficult for the patient won't tolerate any standard airways but can obstruct anyway, and this difficulty is dramatically exacerbated by obesity, a condition increasingly common and associated with health needs, resulting in the likelihood of needing medical procedures or surgery.
Skilled airway managers such as anesthesiologists and anesthetists learn maneuvers to allow an air/gas passage to be maintained in the obtunded patient. Beside head and neck positioning, these chin lift and jaw thrust maneuvers take advantage of the unique anatomy of the human temporo-mandibular joint, a true double joint, a rotating ball joint until fully open, then becoming a cam joint as the mandibular condyle slides forward onto a bony shelf in the anterior portion of the joint, dropping the posterior part of the mandible, stretching the soft tissues and creating an air passage. In the airway maneuvers the mouth is not opened but by pulling the chin (in the patient not breathing) or pushing the angle of the jaw (in the breathing patient) the cam joint action is engaged, the hypopharynx is opened and a patent gas passage from the nose though the pharynx is created.
In American Medicine the number of invasive and uncomfortable procedures has been dramatically increasing, often to replace more invasive or surgical procedures that required general anesthesia. These procedures require some level of sedation so they can be tolerated by the patient, and in most institutions anything requiring more than a mild sedative that should not result in airway obstruction is attended by an anesthesia provider because of the consequences of even the slightest slip up in managing the airway. With aging and greater obesity even mild sedation can be dangerous. A device tolerated by an awake patient that would help maintain an open air passage as they are sedated or anesthetized and conversely could be left in the mouth as they awakened, would enhance the safety of sedation, and make many procedures more acceptable with less risk. Such a device may be used by a monitoring clinician other than an anesthesia provider not unlike the bite block used in endoscopy procedures which this device could replace, making not only a passage for the endoscope but helping maintain the airway. Such procedures may be less costly and more convenient to schedule if an anesthesia provider's attendance is not mandatory. And such a device might be useful in the management of Obstructive Sleep Apnea.